Lower extremity reconstructive surgery is an evolving field with novel strategies and newer techniques constantly being implemented. Recent additions in the field of wound closure and reconstruction include the use of negative-pressure wound therapy and dermal substitutes. These, in turn, have led to a decreased need for complex microsurgical reconstruction in many cases. In circumstances that require microsurgical reconstruction, new techniques for harvesting flaps, including perforator flaps, have proven superior in many applications to those previously used with reduced donor-site morbidity. Strategically designed flaps in microsurgery have led to the ability to restore sensation, structural integrity, function, and, in some instances, vascularity. Techniques for nerve harvest, neurotized flaps, and the use of nerve conduits have made nerve reconstruction a more viable option. Composite tissue allotransplantation may provide the tissue coverage necessary for reconstruction of extremely complex lower extremity wounds with multilayered and multidimensional deficits. Nonsurgical interventions have become increasingly valuable with more defined roles. Pulsed electromagnetic field therapy (PEMF) has demonstrated a role in decreasing postoperative edema and pain as well as improving angiogenesis and wound healing. This adjunctive modality of treatment is becoming more readily available and will likely become more commonly used in the near future. In short, new strategies for reconstruction of the lower extremity are constantly improving the overall reconstructive results.